Credit Application

Company Name: *

Email: *

Owner Name: *

DBA (if any): *

DOT Number *

Valid DOT required to rent or lease

Phone Number *

Fax Number *

Address *

State: *

City: *

Zip: *

Federal Tax ID#: *

Social Security Number of Principal (if other than corporation): *

Name of Principal: *

Select Sic Code: *

Year Business Started *

Current Velocity Vehicle Group customer:* Yes No

D-U-N-S #: *

PO Required?:* Yes No

Billing Contact: *

Email For Receive Invoice *

By filling these credit details, I agree to receive invoices via email *

Resale? Yes No

*If yes please attach a completed resale card

Printed Name: *

Title: *

SIGNATURE *

Credit Application For